ArticleNephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association2024
Proteinuria, measured or estimated albuminuria for risk prediction in patients with chronic kidney disease?
Article in Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers, 1 of them a synthesis that pooled it.
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Who cites it
10 citing papers in PubMed, 1 synthesis or guideline pooled it, 6 citations in OpenAlex.
- Proteinuria or Albuminuria as Markers of Kidney and Cardiovascular Disease Risk : An Individual Patient-Level Meta-analysis.Annals of internal medicine · 2026Pooled it
- Cardiovascular Disease in CKD: Ethnic and Regional Differences in Risk and Phenotype.Clinical journal of the American Society of Nephrology : CJASN · 2026Review
- Can urinary albumin-creatinine ratio be used as a surrogate for protein-creatinine ratio in the diagnosis and management of pediatric steroid sensitive nephrotic syndrome?Pediatric nephrology (Berlin, Germany) · 2026Article
- Inflammatory and traditional risk factors associated with the progression of chronic kidney disease in patients with rheumatoid arthritis.Clinical and experimental nephrology · 2026Article
- Association of UACR and UPCR with kidney failure: analysis of observational data in patients with rare kidney diseases.Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association · 2026Observational
- Assessing Proteinuria after Acute Kidney Injury: Is Urine Protein to Creatinine Ratio Sufficient?Kidney360 · 2026Article
- Ethnic Disparities in CKD Progression: A Comparative Study of CRIC and KNOW-CKD Cohorts.Clinical journal of the American Society of Nephrology : CJASN · 2026Article
- Effect of alprostadil combined with sulodexide on elderly chronic kidney disease patients and the independent risk factors affecting curative results.American journal of translational research · 2026Article
- Development and internal validation of an interpretable machine learning model for predicting dialysis risk in patients with stage 3-4 chronic kidney disease.Frontiers in public health · 2026Article
- Absence of progression risk of chronic kidney disease in patients with urine protein-creatinine ratio below 500 mg/g: a cohort study with competing risk analysis.Frontiers in medicine · 2025Article
Corrections and comments
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Authors and funding
13 authors at 8 institutions in 1 country.
Funding
Abstract
backgroundAlthough albuminuria is the gold standard for defining chronic kidney disease (CKD), total proteinuria has also been widely used in real-world clinical practice. Moreover, the superiority of the prognostic performance of albuminuria over proteinuria in patients with CKD remains inconclusive. Therefore, we aimed to compare the predictive performances of albuminuria and proteinuria in these patients.
methodsFrom the Korean Cohort Study for Outcome in Patients with CKD we included 2099 patients diagnosed with CKD grades 1-5 who did not require kidney replacement therapy. We measured the spot urine albumin:creatinine ratio (mACR) and protein:creatinine ratio (PCR) and estimated the ACR (eACR) using the PCR. Kidney failure risk equation (KFRE) scores were calculated using the mACR, PCR and eACR. The primary outcome was the 5-year risk of kidney failure with replacement therapy (KFRT).
resultsThe eACR significantly underestimated mACR in patients with low albuminuria levels. The time-dependent area under the receiver operating characteristics curve showed excellent predictive performance for all KFRE scores from the mACR, PCR and eACR. However, eACR was inferior to mACR based on the continuous net reclassification index (cNRI) and integrated discrimination improvement index (IDI) in all CKD cause groups, except for the group with an unclassified aetiology. Moreover, the cNRI and IDI statistics indicated that both eACR and PCR were inferior to mACR in patients with low albuminuria (<30 mg/g). Conversely, the predictive performance of PCR was superior in severe albuminuria and nephrotic-range proteinuria, in which the IDI and cNRI of the PCR were greater than those of the mACR.
conclusionsThe mACR, eACR and PCR showed excellent performance in predicting KFRT in patients with CKD. However, eACR was inferior to mACR in patients with low albuminuria, indicating that measuring rather than estimating albuminuria is preferred for these patients.
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